Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/45183
Title: Abnormal Venous Flow in Pregnant Women with Mild Right Ventricular Dysfunction in Repaired Tetralogy of Fallot: A Clinical Model for Organ Dysfunction in Preeclampsia
Authors: Siegmund, Anne S.
GYSELAERS, Wilfried 
Sollie-Szarynska, Krystina M.
Willems, Tineke P.
Roos-Hesselink, Jolien W.
van Veldhuisen, Dirk J.
Hoendermis, Elke S.
Issue Date: 2025
Publisher: MDPI
Source: Journal of Clinical Medicine, 14 (1) (Art N° 142)
Abstract: Background: Pregnant women with congenital heart disease carry a high risk of complications, especially when cardiac function is suboptimal. Increasing evidence suggests that impaired right ventricular (RV) function has a negative effect on placental function, possibly through venous congestion. We report a case series of hepatic and renal venous flow patterns in pregnant women with right ventricular dysfunction after repaired Tetralogy of Fallot (ToF), relative to those observed in normal pregnancy and preeclampsia. Methods: At 20-24 weeks pregnancy, RV function was measured by echocardiography and by cardiovascular magnetic resonance in women with repaired ToF. Combined Doppler-ECG of the hepatic and renal interlobular veins were performed in three women with asymptomatic right ventricular dysfunction. Venous impedance index and pulse transit time were measured and classified as abnormal at >75th and <25th reference percentile, respectively. Results: All three women showed dilated RV and mildly impaired RV function. Both hepatic and intrarenal Doppler flow waves were abnormal and very much resembled the patterns seen in preeclampsia. One of the three women had complications including ventricular tachycardia, intrauterine growth restriction, antenatal bleeding, emergency cesarean section and acute heart failure 2 days postpartum. Conclusions: Pregnant women with mild right ventricular dysfunction after repaired ToF show abnormal venous Doppler flow waves in the liver and kidneys, similar to those observed in preeclampsia. These findings are in line with reported observations on the association between impaired RV function, abnormal return of venous blood, venous congestion and organ dysfunction. The parallel with venous Doppler flow observations in preeclampsia suggest that the venous compartment might play an important role in the etiology of preeclampsia-induced organ dysfunction. Whether this phenomenon directly affects the uteroplacental circulation is to be assessed in future research.
Notes: Siegmund, AS (corresponding author), Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, NL-9700 RB Groningen, Netherlands.
a.s.siegmund@umcg.nl; wilfried.gyselaers@zol.be; k.m.sollie@umcg.nl;
t.p.willems@umcg.nl; j.roos@erasmusmc.nl; e.s.hoendermis@umcg.nl
Keywords: congenital heart disease;congenital heart disease;pregnancy;pregnancy;venous flow;venous flow;right ventricular function;right ventricular function
Document URI: http://hdl.handle.net/1942/45183
e-ISSN: 2077-0383
DOI: 10.3390/jcm14010142
ISI #: 001395988000001
Rights: 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/ licenses/by/4.0/).
Category: A1
Type: Journal Contribution
Appears in Collections:Research publications

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